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Over-the-counter pain relief.

In a typical drugstore, you'll find a multitude of over-the-counter (OTC) products for every sort of pain--as if a different pain reliever were required for everything! Actually, OTC pain relievers are of only two types--NSAIDs and acetaminophen:

There are three nonprescription NSAIDs (nonsteroidal antiinflammatory drugs): aspirin, ibuprofen (such as Advil or Nuprin), and--as of last January--naproxen sodium (brand name Aleve). NSAIDs work by blocking the effects of chemicals called prostaglandins, produced naturally by the body. When certain prostaglandins are present, you feel pain. Naproxen sodium is the new player on the team. Naproxen (brand name Naprosyn) and naproxen sodium (Anaprox) have been sold by prescription as arthritis drugs for several years. Because of naproxen's good record as a pain reliever with relatively few side effects, the FDA approved naproxen sodium (which works faster than plain naproxen) as an OTC pain reliever.

Acetaminophen (such as Tylenol or Panadol) is thought to affect pain centers in the brain. It is effective against pain and fever but not inflammation.

Keep the following tips in mind

* Buy generic. Generics must meet the same standards as name brands. The ads strongly imply that you can't "trust" generics, but it's the ads you should mistrust. Exception: There won't be a generic naproxen sodium until the patent, held by Syntex Laboratories, expires three years hence. Aleve costs about as much as brand-name ibuprofen.

* Avoid combinations of ingredients. They cost more and provide less of the pain reliever you seek. If you have a cold, buy ibuprofen and a decongestant (if you want one). If you have a headache and an upset stomach, buy acetaminophen or aspirin for the first and an antacid for the second.

* Packaging options. Caplets and gel-caps may be easier to swallow. Timed-release capsules offer prolonged relief and may be helpful for muscle soreness or other kinds of low-level continuing pain. Aleve is also long-lasting.

* Effervescent tablets with aspirin (for example, Alka-Seltzer) contain a large amount of antacid, which causes the aspirin to be more quickly excreted and thus reduces its effectiveness.

* Buffered aspirin usually won't prevent upset stomach, since it contains only a small amount of antacid as a buffering agent. On the other hand, enteric-coated pills are easier to swallow and may lessen stomach distress. The coating does slow the absorption of the pain reliever and thus delays pain relief.

* Children under 16 with chicken pox or flu symptoms shouldn't take aspirin because of the risk of Reye's syndrome.

* Alcohol. The Aleve label advises caution when combining frequent use of pain relievers with heavy drinking. Soon other pain relievers will carry such a caution. (Combining alcohol with aspirin or ibuprofen may promote gastrointestinal bleeding. Acetaminophen and alcohol may promote liver damage.)

* Store your pain relievers in a cool, dry place. The bathroom is not ideal.

* Stick with one type of pain reliever at a time.

* Low-dose aspirin taken daily thins the blood and can prevent heart attacks. But this regimen should be undertaken only on medical advice.

* "OTC" does not mean harmless. As with any drug, read labels and follow dosages. If your pain persists, or if pain relievers become a habit, seek professional advice.

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Title Annotation:Buying Guide
Publication:The University of California, Berkeley Wellness Letter
Date:Jul 1, 1994
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